PaP Score Research Articles

Prospective assessment of targeted symptom management on supportive care in cancer: An observational cohort study.

e24073 Background: In advanced cancer, patients may experience treatment-related symptoms or disease burden, necessitating multiple supportive care pharmacotherapies. However, managing these symptoms can lead to complex polypharmacy, potentially resulting in inefficacies or toxicities due to pharmacogenetic interactions. Our study focuses on targeting the most impactful symptom to streamline pharmacotherapy, potentially reducing the need for extensive polypharmacotherapy. By prioritizing management of this "target symptom”, our study seeks to optimize improve overall symptom relief and reduce the need for extensive polypharmacotherapy. Methods: Upon initial palliative care evaluation, the PERSONS score (Pain, Eating/cachexia, Rehabilitation/fatigue, Sleeping disorder, O2/dyspnea, Nausea/emesis, Suffering; each item rated 0-10, total score 0-70) was used to screen for cancer-related symptoms and identify a treatment-specific target symptom for each enrolled patient. Accordingly, a personalized palliative care intervention was implemented based on the identified target. Efficacy of this strategy was then assessed by monitoring changes in the PERSONS score after approximately 10 days of treatment. Non-parametric statistical tests were employed to evaluate differences in symptom distributions between baseline and post-treatment scores: the Wilcoxon signed-rank test for comparisons between two groups and the Kruskal-Wallis test for comparisons across more than two groups. All analyses were conducted using R v4.1. Results: Among 72 prospectively enrolled patients, most had intermediate KPS scores (30-40, 47%; 50-60, 33%) and were not on active treatment (73%); PaP score was A, B and C in 27%, 61% and 11% of patients, respectively. The median PERSONS score at baseline was 26 (range 9 to 51). Pain was identified as the target symptom in 33 (47%) of patients, followed by dyspnea (14%), fatigue (11%), suffering (11%), nausea/emesis (7%) and cachexia (7%). When identified as a target symptom, suffering had numerically higher scores (range, 7-10; Kruskal-Wallis p = .14). PERSONS scores across non-target symptoms were numerically higher in patients with fatigue, pain and nausea/emesis identified as target symptoms. After a median of 9.5 days (range 6 to 138) of targeted treatment, PERSONS scores across non-target symptoms were significantly lower (p = 7.9e-05; median difference = -6, range = -24 to +10), as was intensity of target symptoms (p = 7.2e-14). Conclusions: Focusing on a targeted symptom through a short treatment course not only reduced that specific symptom but also demonstrated clinically significant improvements in non-target symptoms. This comprehensive approach, emphasizing the interconnectedness of symptoms, has the potential to optimize patient care and enhance clinical outcomes in the context of advanced cancer management.

Evaluation of the Novel PAP Score and Other Fibrosis Scores as Non-Invasive Alternative for Upper GI Endoscopy in Detection of Large Esophageal Varices in HCV-Induced Liver Cirrhosis

Evaluation of the Novel PAP Score and Other Fibrosis Scores as Non-Invasive Alternative for Upper GI Endoscopy in Detection of Large Esophageal Varices in HCV-Induced Liver Cirrhosis

Meridian energy analysis may predict the prognosis of patients with advanced cancers receiving palliative care.

A better understanding of irreversible prognoses in palliative care is crucial for improving patients' quality of life and their sense of dignity. We examined whether measurements of meridian electrical conductance can noninvasively and objectively predict survival time in a hospice patient population. This was a single-center cohort study. Between 2019 and 2020, we measured skin conductance from 24 representative acupoints of 12 meridians on both sides of the body in 181 advanced cancer patients within 48h of hospitalization and monitored their survival time. The Palliative Prognostic Score (PaP Score) was calculated for each patient, classifying them into one of three prognosis groups: Group A, B, or C. Factors associated with short-term and long-term survival were identified using multivariate regression analysis. Statistical differences in survival times were analyzed between the meridian electrical conductance measurements and PaP Scores. Analyses of the clinicopathological data from terminal cancer patients revealed that male sex, mean meridian electrical conductance measurements of ≤8.8μA, and PaP Scores in Group C were independent predictors of short-term survival. Mean meridian electrical conductance measurements of ≤8.8μA demonstrated good sensitivity (85.1%) and adequate specificity (60.6%) for short-term survival. A survival curve analysis revealed a mortality rate of 90.6% at 30 days among patients with meridian electrical conductance measurements of ≤8.8μA. A mean meridian electrical conductance measurement of ≤8.8μA can objectively assess short-term survival with advanced cancer and reduce nonbeneficial medical treatment.

Arabic machine reading comprehension on the Holy Qur’an using CL-AraBERT

In this work, we tackle the problem of machine reading comprehension (MRC) on the Holy Qur’an to address the lack of Arabic datasets and systems for this important task. We construct QRCD as the first Qur’anic Reading Comprehension Dataset, composed of 1,337 question-passage-answer triplets for 1,093 question-passage pairs, of which 14% are multi-answer questions. We then introduce CLassical-AraBERT (CL-AraBERT for short), a new AraBERT-based pre-trained model, which is further pre-trained on about 1.0B-word Classical Arabic (CA) dataset, to complement the Modern Standard Arabic (MSA) resources used in pre-training the initial model, and make it a better fit for the task. Finally, we leverage cross-lingual transfer learning from MSA to CA, and fine-tune CL-AraBERT as a reader using two MSA-based MRC datasets followed by our QRCD dataset to constitute the first (to the best of our knowledge) MRC system on the Holy Qur’an. To evaluate our system, we introduce Partial Average Precision (pAP) as an adapted version of the traditional rank-based Average Precision measure, which integrates partial matching in the evaluation over multi-answer and single-answer MSA questions. Adopting two experimental evaluation setups (hold-out and cross validation (CV)), we empirically show that the fine-tuned CL-AraBERT reader model significantly outperforms the baseline fine-tuned AraBERT reader model by 6.12 and 3.75 points in pAP scores, in the hold-out and CV setups, respectively. To promote further research on this task and other related tasks on Qur’an and Classical Arabic text, we make both the QRCD dataset and the pre-trained CL-AraBERT model publicly available.

Prevalence of Delirium in Advance Cancer Patients Admitted in Hospice Centre and Outcome after Palliative Intervention.

The assessment of prevalence of delirium in advanced cancer patients admitted in hospice centre and outcome after palliative intervention. The possible related risk factors for development of delirium. This was prospective analytic study done at hospice centre attached with tertiary cancer hospital in Ahmedabad during August 2019 - July 2021. This study was approved by the Institutional Review Committee. We selected patients according to following inclusion criteria (all patient admitted to hospice centre above 18 years, with advance cancer disease and on best supportive care) and exclusion criteria (Lack of informed consent, Inability to participate in study due to mentally retard or coma). The following information were collected: age, gender, address, type of cancer, comorbidities, history of substance abuse, history of (h/o) palliative chemotherapy or radiotherapy within last 3month, general condition, ESAS (Edmonton symptom assessment scale), ECOG (Eastern cooperative oncology group), PaP score (palliative prognostic score), medication including opioids, NSAIDs (Non-steroidal anti-inflammatory drugs), steroids, antibiotic, adjuvant analgesic, PPI (Proton pump inhibitor), anti-emetic etc. Delirium diagnosis was based on diagnostic criterion of DSM-IV text revised and MDAS. In our study we found prevalence of delirium was 31.29% in advanced cancer patients admitted to hospice centre. We found most common type of delirium is hypoactive (34.7%) and mixed subtype (34.7%) followed by hyperactive (30.4%) delirium. Resolution of delirium was higher among hyperactive delirium (78.57%) followed by mixed subtype (50%) and hypoactive (12.5%). Mortality was higher among patient with hypoactive subtype (81.25%) followed by mixed (43.75%) and hyperactive delirium (14.28%). An identification and assessment of delirium is vital for acceptable end of life care within the palliative care in light of the fact that the presence of delirium is related with morbidity, mortality, prolonged ICU hospitalization, expanded time on a ventilator, and by and large more prominent medical services costs. Clinicians should utilize one of a few approved delirium assessment tools to help evaluate and archive cognitive function. Prevention and recognizing the clinical reason for delirium are generally the best method for diminishing the morbidity from delirium. The study results demonstrate that multi component delirium management or projects are generally proficient to lessen the prevalence and negative outcomes of delirium. It was found that palliative care intervention has quite a positive outcome as it not only focus on the mental health of the patients but also of family members who go through the same amount of distress and also help them to communicate properly and manage to settle the mental state and end the life without pain and distress.

Prognostication in palliative radiotherapy—ProPaRT: Accuracy of prognostic scores

BackgroundPrognostication can be used within a tailored decision-making process to achieve a more personalized approach to the care of patients with cancer. This prospective observational study evaluated the accuracy of the Palliative Prognostic score (PaP score) to predict survival in patients identified by oncologists as candidates for palliative radiotherapy (PRT). We also studied interrater variability for the clinical prediction of survival and PaP scores and assessed the accuracy of the Survival Prediction Score (SPS) and TEACHH score.Materials and methodsConsecutive patients were enrolled at first access to our Radiotherapy and Palliative Care Outpatient Clinic. The discriminating ability of the prognostic models was assessed using Harrell’s C index, and the corresponding 95% confidence intervals (95% CI) were obtained by bootstrapping.ResultsIn total, 255 patients with metastatic cancer were evaluated, and 123 (48.2%) were selected for PRT, all of whom completed treatment without interruption. Then, 10.6% of the irradiated patients who died underwent treatment within the last 30 days of life. The PaP score showed an accuracy of 74.8 (95% CI, 69.5–80.1) for radiation oncologist (RO) and 80.7 (95% CI, 75.9–85.5) for palliative care physician (PCP) in predicting 30-day survival. The accuracy of TEACHH was 76.1 (95% CI, 70.9–81.3) and 64.7 (95% CI, 58.8–70.6) for RO and PCP, respectively, and the accuracy of SPS was 70 (95% CI, 64.4–75.6) and 72.8 (95% CI, 67.3–78.3).ConclusionAccurate prognostication can identify candidates for low-fraction PRT during the last days of life who are more likely to complete the planned treatment without interruption.All the scores showed good discriminating capacity; the PaP had the higher accuracy, especially when used in a multidisciplinary way.

Prognostication in patient with terminal stage of cancer

Prognosis is one of the most critical factors affecting clinical decision in medical practice. In terminal illness where patients are only less than months to live, prognostication is essential to provide an appropriate plan, particularly to avoid futile treatment and to arrange palliative care referral. Prognostication is a process of foreseeing and foretelling, which enable the health care team, patients and family to be involved in the decision making. Determining prognosis is a challenge for doctors as lack of knowledge and skills and fear of the response of the patients and their families. Prognostication is essential in decision making among terminally ill patients, as the risks of adverse effects, energy, time and cost potentially outweighs the benefit of survival, quality of life, functional gain and hope. The benefit of prognostication is not only for the doctors, but particularly to the patients, their families, as well as to institution and health care system. In daily practice a subjective judgment made by doctor based on clinical assessment is usually overoptimistic. A tool is needed to make a better prognostication. Palliative Prognostic Index (PPI) and Palliative Prognostic Score (PaP score) are the most common tools used in palliative care setting.

Therapeutic Futility in Terminal Cancer Patients: A Retrospective and Observational Study.

IntroductionAdvanced cancer patients often need therapy for symptomatic control, in addition to cancer and other disease treatments. As the cancer disease progresses and life expectancy decreases, there should be a change in the goal of care. If this change is not accompanied by therapeutic adjustments, there is a risk of maintaining useless and ineffective treatments, as well as potential harmful drug interactions. This study analyzed the prevalence of therapeutic futility in patients with advanced cancer disease.Materials and methodsThis was a retrospective and observational single-center study, that included advanced cancer patients who died during the hospital stay, at a University Hospital in Lisbon, Portugal. Demographic and clinical data were collected. A Palliative Prognostic Score (PaP) was used to stratify patients according to their prognosis group. An analysis of the prescribed therapy was performed to quantify the “potentially inappropriate medications” (PIMs) and “inappropriate medications” (IMs), at admission and 24 hours prior to the patient’s death.ResultsOver 140 patients were included. On the first day of hospitalization, 119 patients (85%) were exposed to at least one IM or PIM and 100 patients (71%) were still exposed to at least one IM or PIM in the last 24 hours of life. Regarding chemotherapy, 66 patients (47%) had treatment in the last two months of life, 38 (27%) in the last month, and 17 (12%) in the last two weeks prior to death.Therapeutic simplification (suspension of IMs and reduction of at least 50% of PIMs during hospitalization) was performed in 43% of the overall population and was higher in PaP score group C, but not statistically significant (p=0.09). The patient's inclusion in PaP score group C and inpatient consultation by the palliative care team were independent predictors of therapeutic simplification.DiscussionThere is an effort to achieve greater therapeutic suitability in palliative patients. However, many patients maintain futile and disproportionate therapy at the end of life (EoL). In many cases, systemic cancer treatment is performed until quite late in the course of the disease. The prescription of PIMs was significantly higher than that of IMs, which could be expected given their definition. A shorter life expectancy at admission led to a greater therapeutic simplification, as well as an intervention by the Palliative Care Team, which can be explained by the more focused approach towards quality-of-life improvement and symptomatic control. Different than expected the prescription of supportive therapies at hospital admission was not a predictor of therapeutic simplification. Although there was a reduction in IMs and PIMs in the studied population, and therapeutic simplification occurred in one fraction of the patients, the fact is that more than half of the patients evaluated did not undergo therapeutic simplification as defined in this work.ConclusionIt appears that there is an effort to achieve greater therapeutic suitability in palliative patients, however, many patients maintain futile therapy at the EoL. It is of paramount importance to change the standard of care in this setting, to privilege a more patient-focused approach and tailored therapy, and to prioritize symptomatic control and quality-of-life improvement.

1521P Polypharmacy and therapeutic futility in patients near the end of life

The goal for end-of-life cancer patients should be symptom control and improving quality of life through therapeutic optimization and discontinuing futile therapy. However, the maintenance of unneeded drugs is frequent, increasing the risk of harmful drug interactions. The aim of this study was to quantify the number of patients with advanced cancer receiving unnecessary therapies and identify points for improvement in clinical practice. This was a retrospective and observational single-centre study, which included cancer patients that died in the medical oncology unit during a 24 month period. A prognostic score (PaP score) was applied retrospectively. The last chemotherapy (ChT) treatment and drugs prescribed at admission and 24 hours prior to death were analysed and were potentially inappropriate medications (PIMs) were identified. Seventy-four patients were included in the study. On day 1, 89.2% were exposed to at least one PIM, mainly cardiovascular drugs (28.4%), anticoagulants (43.2%), and proton pump inhibitors (74.3%). Twenty-seven patients (36.5%) had a PaP score > 11 (30 day survival probability < 30%). However, there was no significant difference in terms of PIMS in the group with a PaP score > 11 compared to the overall cohort. Therapeutic simplification occurred in 27 patients (36.5%), but PIMs were maintained in 70.3% of patients. Regarding ChT, 34% of patients had ChT in the last two months of life, and 8% in the last two weeks. The prevalence of polypharmacy and PIMs in advanced cancer patients is high. There is a clear need to perform regular prognostic assessments and apply validated prognostic scores to improve clinical practice. Prescriptions must be assessed continuously, aiming to reduce inappropriate drugs, including discontinuation of oncospecific therapy, and favouring symptomatic control and quality of life.

EXPRESS: Sildenafil for bronchopulmonary dysplasia and pulmonary hypertension: a meta-analysis.

Bronchopulmonary dysplasia (BPD) is the most common complication in preterm infants and often complicated by pulmonary hypertension (PH), leading to substantial morbidity and mortality. Sildenafil is often used to treat PH and improve symptoms in this condition, even though evidence of safety and effectiveness is scarce. The aim of this study was to perform a systematic review and meta-analysis about the effectiveness and safety of chronic use of sildenafil in preterm infants with BPD-associated PH. Data sources were PubMed, EMBASE, and Medline. Studies reporting the effectiveness of sildenafil therapy in BPD-associated PH in newborns and infants were included. All-cause mortality, improvement in PH, improvement in respiratory scores, and adverse events were extracted. Five studies were included, yielding a total of 101 patients with 94.2 patient-years of total follow-up. The pooled mortality rate was 29.7%/year (95% confidence interval [CI] = 6.8–52.7). Estimated pulmonary arterial pressure improved > 20% in 69.3% (95% CI = 56.8–81.8) of patients within 1–6 months. Respiratory scores improved in 15.0% (95% CI = 0.0–30.4) of patients within 2–7 days. There were no serious adverse events during sildenafil therapy. This systematic review shows that in the treatment of BPD-associated PH in preterm infants, sildenafil may be associated with improvement in PAP and respiratory scores. However, there is no clear evidence of its effect on mortality rates. Considering BPD as a complex disease with variable expression patterns, these results support the need for a prospective registry and standardized approach.

Evaluación prospectiva de la herramienta Palliative Pronostic Score en pacientes con enfermedad oncológica avanzada en manejo con cuidado paliativo de soporte

Objetivo: Evaluar la herramienta Palliative Prognostic Score (PaP Score) en pacientes con cáncer avanzado atendidos en la unidad de cuidados paliativos y dolor en el Instituto Nacional de Cancerología, Bogotá, Colombia. Materiales y métodos: A una muestra de 100 pacientes atendidos por el grupo de Cuidados paliativos, ingresados al área de hospitalización del Instituto Nacional de Cancerología de Bogotá, desde el 13 octubre de 2015, seleccionados consecutivamente, se les aplicó el índice pronóstico de supervivencia PaP Score, para establecer clasificación de supervivencia (grupos A, B y C) a 30 días. Se analizó la supervivencia, usando el método de Kaplan-Meier y el test de log-rank para comparar la distribución de la supervivencia en los tres grupos del PaP Score. Resultados: El PaP Score dividió la muestra de pacientes en tres categorías pronósticas: 15 pacientes en el grupo A (con una probabilidad de supervivencia a un mes mayor del 70%), 36 pacientes en el grupo B (con una probabilidad del 30 al 70%) y 49 pacientes en el grupo C (con una probabilidad menor del 30%). El porcentaje de pacientes vivos a los 30 días estuvo dentro de los límites esperables en cada grupo; así, en el grupo A (probabilidad de supervivencia mayor de 70%) fue de 93,3%, en el grupo B (probabilidad del 30 al 70%) fue 41,7%, y en el grupo C (probabilidad menor de 30%) fue del 8,1%. Conclusiones: El uso del índice PaP Score permite clasificar a los pacientes en tres categorías pronósticas de supervivencia ofreciendo una opción para la estimación clínica de la misma, en pacientes con cáncer avanzado, atendidos en una unidad de cuidados paliativos; esta herramienta es fundamento para que el médico especialista optimice y enfoque los cuidados al final de la vida del paciente y su familia.

469P - Validation of the palliative prognostic score (PaP score) in patients with metastatic cancer in RSUP Dr. Sardjito, Yogayakarta, Indonesia

469P - Validation of the palliative prognostic score (PaP score) in patients with metastatic cancer in RSUP Dr. Sardjito, Yogayakarta, Indonesia

Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1week of palliative care.

The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1week of palliative care. A consecutive sample of patients was screened for delirium in period of 1year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected. Possible causes or factors associated with delirium were looked for. The Edmonton Symptom Assessment Scale was used to assess physical and psychological symptoms and the Memorial Delirium Assessment Scale (MDAS) to assess the cognitive status of patients, at admission (T0) and 1week after palliative care (T7). Of 848 patients screened, 263 patients were evaluated. Sixty-six patients had only the initial evaluation. The mean Karnofsky status was 34.1 (SD=6.69); the mean PaP score at admission was 6.9 (SD=3.97). The mean duration of palliative care assistance, equivalent to survival, was 38.4days (SD=48, range 2-220). The mean MDAS values at admission and after 1week of palliative care were 6.9 (SD=6.71) and 8.8 (SD=8.26), respectively. One hundred ten patients (41.8%) and 167 patients (67.3%) had MDAS values ≥7 at admission and after 1week of palliative care, respectively. Age, dehydration, cachexia, chemotherapy in the last three months, and intensity of drowsiness and dyspnea were independently associated with a MDAS>7. A worsening of drowsiness, the use of opioids, and the use of corticosteroids were independently associated with changes of MDAS from T0 to T7. Although the prevalence of delirium seems to be similar to that reported in other acute settings, delirium tended to worsen or poorly responded to a palliative care treatment. Some clinical factors were independently associated with delirium. This information is relevant for decision-making when delirium does not change despite a traditional intervention. Continuous assessment of delirium should be performed in these settings to detect deterioration of cognitive function. Further studies should elucidate whether an earlier approach to palliative care would decrease the prevalence of delirium at a late stage of disease.

Development and evaluation of a novel score for prediction of large oesophageal varices in patients with hepatitis c virus-induced liver cirrhosis

Objective: Variceal bleeding is one of the most common life-threatening complications of liver cirrhosis. This study aimed to develop and evaluate a predictive score, named Platelet count, Alpha fetoprotein (AFP) and Prothrombin-INR (PAP) for the prediction of large oesophageal varices and to compare PAP score with eight common liver fibrosis scores (AAR, APRI, GUCI, BRC score, Fibro-Alfa, FIB4, Lok and Fibro-Q) in patients with hepatitis C virus (HCV) induced liver cirrhosis.Methods: A total of 277 patients with HCV-induced liver cirrhosis were evaluated by upper gastrointestinal endoscopy for presence of varices. Liver biochemical profile, complete blood count, prothrombin time and AFP were estimated. Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were used to create a predictive score (PAP score) comprising platelet count, AFP and prothrombin-INR.Results: PAP score predicts large oesophageal varices in patients with HCV-induced liver cirrhosis with AUC of 0.85. The optimum cut-off for predicting large oesophageal varices using ROC curve analysis was 0.27. At this point the PAP score had 77% sensitivity, 86% specificity, 94% negative predictive value and 84% efficiency. The diagnostic performances (AUC) of eight common liver fibrosis scores were 0.58 for the AAR score, 0.63 for APRI, 0.66 for GUCI, 0.68 for BRC, 0.72 for Fibro-Alfa, 0.70 for FIB4, 0.72 for Lok and 0.77 for Fibro-Q.Conclusion: PAP scores a non-invasive, inexpensive and simple score that could predict the presence of large oesophageal varices reducing the need of endoscopy. The PAP score has a superior AUC score than other scores, suggesting improved clinical value.

Survival prediction for advanced cancer patients in the real world: A comparison of the Palliative Prognostic Score, Delirium-Palliative Prognostic Score, Palliative Prognostic Index and modified Prognosis in Palliative Care Study predictor model

PurposeThe aim of this study was to investigate the feasibility and accuracy of the Palliative Prognostic Score (PaP score), Delirium-Palliative Prognostic Score (D-PaP score), Palliative Prognostic Index (PPI) and modified Prognosis in Palliative Care Study predictor model (PiPS model). Patients and methodsThis multicentre prospective cohort study involved 58 palliative care services, including 19 hospital palliative care teams, 16 palliative care units and 23 home palliative care services, in Japan from September 2012 to April 2014. Analyses were performed involving four patient groups: those treated by palliative care teams, those in palliative care units, those at home and those receiving chemotherapy. ResultsWe recruited 2426 participants, and 2361 patients were finally analysed. Risk groups based on these instruments successfully identified patients with different survival profiles in all groups. The feasibility of PPI and modified PiPS-A was more than 90% in all groups, followed by PaP and D-PaP scores; modified PiPS-B had the lowest feasibility. The accuracy of prognostic scores was ⩾69% in all groups and the difference was within 13%, while c-statistics were significantly lower with the PPI than PaP and D-PaP scores. ConclusionThe PaP score, D-PaP score, PPI and modified PiPS model provided distinct survival groups for patients in the three palliative care settings and those receiving chemotherapy. The PPI seems to be suitable for routine clinical use for situations where rough estimates of prognosis are sufficient and/or patients do not want invasive procedure. If clinicians can address more items, the modified PiPS-A would be a non-invasive alternative. In cases where blood samples are available or those requiring more accurate prediction, the PaP and D-PaP scores and modified PiPS-B would be more appropriate.

H-index is important for postural control for people with impaired foot sole sensation.

IntroductionPeople with Peripheral Neuropathy (PN), especially those with impaired sensory inputs through the small-afferent fiber (type II afferent fibers) reflex loop (SAF), might depend more on the large-afferent fiber (type I afferent fibers) reflex loop (LAF) for postural control.PurposeTo examine whether the function of the LAF reflex loop, reflected by the H-reflex and ankle joint proprioception, influences postural control when the SAF reflex loop is impaired, as indicated by reduced foot sole cutaneous sensation.MethodsThirteen participants (8 women, 5 men) diagnosed with PN and 12 age-matched controls (7 women, 5 men) completed the testing protocol. Measures of interest included the H-index, active (AAP) and passive (PAP) ankle proprioception, plantar pressure sensitivity (PPS), average sway velocity (VAVG) and area (A95) during 30 seconds eyes-closed standing, 6-minute walk distance (6MWD) and timed up-and-go duration (TUG).ResultsStatistically significant group-dependent regression was observed between VAVG and H-index. Compared to the control group, the PN group demonstrated reduced PPS (2.0 ± 1.9 vs. 4.2 ± 1.2, P < .05) and H-index (63.6 ± 10.9 vs. 76.4 ± 16.0, P < .05), greater VAVG (3.5 ± 2.1 vs. 1.6 ± 0.6cm/s, P < .05) and A95 (10.0 ± 10.1 vs. 2.5 ± 1.5cm2, P < .05), shorter 6MWD (442.2 ± 93.0 vs. 525.3 ± 68.2m, P < .05), and longer TUG (9.4 ± 1.6 vs. 6.5 ± 1.3s, P < .05). Within the PN group, but not the control group, the H-index was correlated with VAVG (r = -.56, P < .05). Moreover, within the PN group only, PAP scores were correlated with 6MWD (r = -.68, P < .05) and TUG (r = -.59, P < .05) performance. No other statistically significant group difference, correlation or group-dependent regression was observed.ConclusionVAVG, 6MWD, and TUG correlated with LAF reflex loop function observed among those with impaired functioning of the SAF reflex loop. This observation suggests that the LAF reflex loop may be critical to the control of balance in those individuals suffering from small-fiber PN.

Estudio comparativo de la escala Palliative Prognostic Score y la estimación de los médicos en la supervivencia de la enfermedad oncológica terminal

ObjectiveTo examine the experience in the routine use of the Palliative Prognostic Score (PaP score) as a predictor of survival in terminal cancer patients and to compare it with the estimation of the patients’ survival made by doctors, as well as comparing this with the actual survival of the patients. The survival data provided by the scale are also analyzed, together with the specific characteristics of the studied group. MethodsA prospective study was conducted on 100 consecutive patients with advanced terminal cancer admitted to a Hospital Palliative Care Unit. The PaP score was applied by 2 physicians, with at least 15 years experience, when the patients were admitted. This scale assesses 6 variables that give a score that classifies patients into 3 different probabilistic groups of survival at one month. One of these 6 variables was the physician's estimation, which was analyzed and compared with the predictions of the scale. The data were collected in a database and analyzed using IBM-SPSS version 18. Medians of survival were analyzed for each group established by the PaP score, and were compared with the actual and physician's predictions. The Spearman correlation coefficient between survivals was calculated by linear regression.The differences between the evaluations made by the 2 doctors were not compared as this was not the reason for the study. ResultsOf the 100 patients analyzed, the scale distinguished 3 different probabilistic groups of survival, analyzing the percentage of compliance to the scale:Group A; high probability of surviving one month, with a total number of 13 patients. In this group only 53.8% of cases survived.Group B; intermediate probability of surviving one month, with a total number of 32 patients, where the 90% of patients did not survive for one month.Group C; with low probability of surviving one month, with a total number of 55 patients, where the 96.4% of the cases did not survive for one month.The median survival, estimated by the scale (SE), estimated by the physician (SM), and the actual survival of patients (SR) was calculated.In group A, with a SE of 33 days, the SR was 31.69 days, and SM was 79.48 days; in group B with a SE of 13.5 days, the SR was 17.53 days and the SM was 48.36 days, and in group C with a SE of 7 days, the SR was 10.36 days with an SM of 21.7 days.In group A, the doctors overestimated 2.5 times above the actual survival, while in group B and C it was overestimated 2.75 and 2.09 times, respectively.The Spearman correlation coefficient between the actual and predicted survival by physicians was 0.64, indicating a good correlation, although with a tendency to overestimate. ConclusionsPaP score scale predictions were acceptably fulfilled in all 3 groups classified by the scale. The survival estimated by an experienced physician had an acceptable correlation when compared with actual survival, although with a tendency to overestimate. When the prognosis was worse, the physician predictions were better.

Características de la anemia en los pacientes oncológicos en tratamiento paliativo

ObjectiveTo study anaemia in cancer patients as well as the type of treatment used in a Palliative Care Unit (PCU). Patients and methodDescriptive, prospective observational study of patients admitted to the General University Hospital PCU of Ciudad Real during a one year follow up (June 2010-2011) who had an anaemic syndrome. The study protocol included epidemiological data, type of tumour, and the treatment received for anaemia. Control of symptoms was measured with the ESAS scale, and patient survival with the PaP Score scale. ResultsThe unit admitted 208 patients during the study period, of whom 65 (31.2%) were included. Of these, 37 (57%) were male and 28 (43%) were female. The mean age of the patients was 70.5 years. The reason for admission was anaemic syndrome in 7 (10.8%) of the cases. The most common type of tumour was gastrointestinal 25 (38.5%), followed by urological 15 (23.1%), and lung 14 (21.5%). The most common aetiology was receiving previous chemotherapy, followed by chronic disorders, folic acid and iron deficiency. In 19 (29.2%) cases the aetiology was multifactorial, and in 16 (24.6%) unknown. Forty-two treatments were administered to 22 (33.8%) patients: 15 with folic acid, 13 with iron, 12 transfusions of red blood cells, and 2 with vitamin B12. According to the PaP Score, 38.4% of patients were in group A, 44.6%, in group B, and 17% in group C. ConclusionsThe anaemia in cancer patients receiving palliative treatment is of various aetiologies.

Pre-Operative Velocity Vector Imaging To Predict the Need for Right Ventricular Support in Patients Undergoing Left Ventricular Assist Device Implantation

<h3>Purpose</h3> The aim of this study was to predict right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implant by preoperative assessment of RV global myocardial systolic strain and strain rate using velocity vector imaging. Novel 2D echo parameters may prove useful in preoperatively identifying patients at high risk for RV dysfunction post LVAD implant. <h3>Methods and Materials</h3> Between Jan 1^st 2010 and Dec 31^st 2011, 39 consecutive patients who received a HeartMate II LVAD underwent a pre-operative 2D ECHO. The RV systolic myocardial longitudinal velocity, strain and strain rate were measured using dynamic 2D vector velocity imaging as markers of RV performance. The primary endpoint was death or implant of a RV assist device (RVAD) due to acute RV failure within 6 months after LVAD implant. <h3>Results</h3> RV failure occurred in 25 of 39 patients (64%) after LVAD placement. Despite inotropic support, inhaled nitric oxide and RVAD support 11 patients of the 25 who developed RV failure expired. A preoperative RV global systolic myocardial strain cut off of -3% had a sensitivity of 73% and a specificity of 86% in predicting post LVAD implant RV failure. RV global strain was an independent predictor of RV failure in a multivariate model (including RV free wall strain, mean PAP, RV EF and Michigan score) (AUC was 0.81). [figure 1] <h3>Conclusions</h3> Poor intrinsic RV myocardial function is associated with a higher mortality in LVAD patients. Dimensionless RV parameters, derived from 2-dimensional speckle tracing echocardiography imaging, particularly, peak systolic global RV strain appears to be promising in predicting LVAD patients who require RVAD.

4234 POSTER Prediction of Survival of Terminal III Cancer Patients – Use of PaP Score by Nurses

4234 POSTER Prediction of Survival of Terminal III Cancer Patients – Use of PaP Score by Nurses